Provider Demographics
NPI:1912200932
Name:PALMER, THOMAS JUSTIN (RN CRNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUSTIN
Last Name:PALMER
Suffix:
Gender:M
Credentials:RN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1786
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:251-281-1162
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1786
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:251-281-1162
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096501363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1912200932OtherNPI